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tv   Book TV After Words  CSPAN  July 23, 2012 12:00am-12:59am EDT

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up next on book tv, after words, with guest host, judith warner. this week, author kaitlin bell
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barnett talks about her first book: "dosed: the medication general race grows up" she explores the debate over plea describing psychiatric drugs for minors diagnosed with mental health issues. >> kaitlin in dosed, you have done something uyankee, which is telling the story of the generation of kids who are perhaps the first in large numbers who have grown up taking psycho tropic medication. how did you get the idea to do that and why and how did that idea come to you? >> first of all, thanks so much for having me and interviewing me, judy. i appreciate it. i got the idea, i read a column in the "new york times" that what a case study of a young woman who had spent almost 20 years taking antidepressants, and she wondered how it affected
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her and there was little scientific research talking about the way this affect chirp's development. so that got me curious. i thought the studies don't exist but i have been taking medication since i was a teenager, and i figured there must be huge numbers of people in my position and i would be curious to get their stories and they're take on how it turned out for them. >> host: was it a difficult project? we have so much conversation so much debate on this subject right now in america, and that's been true actually for decades and you chart that really nicely in your book, how the conversation shaped up, how it's changed over the years, how it has or hasn't dovetailed with changes in scientific knowledge. you were taking what was essentially a very compassionate view from the start because you are looking to give kids, young adults, really now, the people you're talking to a voice.
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did you find you were up against a lot of preconceived notions in trying to get started or were you from the start allowed to kind of have a blank slate and move forward? >> guest: i would say i was not up against my preconceived notions but i think there are a lot of societal preconceived notions and when i tried to interview experts, one thing i found get their take on how medications affected young people and their clinical experience, especially with researchers. i it wasn't an idea they were accustomed to thinking about. we're so used to debating it in binary terms are do these drugs work or are kids overmethod indicated, but to get a more nuanced look at it, what this quality of the experience, was a new question. >> host: did you find the researchers were doing it?
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it varied. the clinicians were happy i was doing and it the people who did both research and also saw patients on a regular basis, thought it was good question to ask and they had indeed seen this in their own practice. the researchers were a little more focused on what did the studies say? we don't have these studies, and they were a little stumped. >> host: there are some studies -- strikingly few. can you tell me about those? >> guest: i should distinguish between the social science researchers and i was talking to and also the working scientists. so, the scientists, this was sort of not a question on their ray car screen but the social scientists, there's a small group of them who i think are doing some fascinating and pioneering work, doing a formal version of what i do in the book, which is to ask young
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people about the qualitative experience of taking medications and how it shaped their and shaped their identity, and it wasn't too hard to find them. they were extremely excited i was exploring this topic, and i was extremely excited they were exploring this topic because it was great to be able to have a little bit of a larger body of research to draw on. >> host: it's great to be able to really kind of bring the greater richness to a debate that has been pretty sterile and gone a long the same lines for all of decades, are kids overmedicated, get can quick solutions to complicated problems? and it's fax you took the debate beyond the simple storylines we have become too familiar with. you said you didn't go into it with any preconceptions. you had an open mind. you had your own concrete experience to draw on that kind of divided the subject for you.
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can you talk about your own experience and how this led into the project and maybe led you to connect better with the young adults weyear interviewing? >> guest: sure. i would say my depression -- and in retrospect my anxiety, although it wasn't identified as such -- began when i was 12 years old. i had a traumatic medical experience. i had scoliosis. i had trouble social live at school because i had to leave for medical appointments all the time, and it made be very self-conscious about my body. and i developed an eating disorder. i think, as a result of those body issues, and that is what landed me into therapy when my parents found out. i was in therapy for a couple of years, didn't find it to be very useful. they thought my underlying issues were not the eating disorder but the depression and the anxiety, but then i lived in a small town, there were only a couple of therapists. there weren't at lot of different methods or options opo
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draw on, and i kept wishing there was some other solution, and i had heard about medication, and i knew people who had taken medication, and i knew that it helped them, and i kept wishing somebody would offer it to me. and nobody did. and so finally i just took the initiative and i talked to my parents and my pediatrician about it myself. >> host: how old were you? >> guest: i was 17 but i had been thinking about medication for at least two years. >> oo so that a longtime, 12 to 17, that's a really long time to suffer with anxiety and depression in sort of getting therapy that sounds like wasn't terribly effective. >> guest: that made me more confident in the decision to ask for medication, and i think that distinguishes my experience from some of the experiences i detail in "dosed" where the kids were younger and didn't know anything about the medication. or -- and didn't even go perhaps
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for a very long time being aware of the way they were impaired. i went for years being acutely aware of this, as i say in the book, writing poetry, english poetry, and hoping for a way out. so i would dry a distinguishment -- distinction between people who start medication at an older age, like i did, and those who begin it much younger. >> host: it sounds as if you had a well-developed vocabulary for understanding what you were going through and a fair bit of knowledge about mental health and treatment options. what year was this or years were this? >> guest: this would have been the late '90s. through the turn of the millennium. >> host: so we were pretty well into the prozac era. now medications along the lines of prozac. a lot of media reporting around them, which you point out in the
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book, was extremely positive, to the point of jubilant. in retrospect do you think the media coverage was helpful or gave you unrealistic expectations? >> guest: i think at the beginning it was helpful because it gave me the confidence to ask for a medication that, like i said, nobody was offering to me, and that i felt i really needed. in retrospect, when i look at this -- especially the paradigm of the chemical imbalance, which we learned is over simplified and there's so men factors that go into these mood and behavior disorders. i think it did lead know think that medication would be a quick fix, and it was at first. it was -- worked really well for me, and then when it stopped working, it was a shock and i was not prepared to think that this is going to be a continuing struggle. >> host: were you able to continue therapy or find better therapy over the year once you had success with medication?
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>> guest: it took me a while. it took until i had had a couple of really bad nervous episodes where i was experiencing new symptoms and i feet like i needed something beyond the medication. and also i was able to find therapists in the city who i thought were really smart, just really sensitive and had a really nuanced take on what i was going through. >> host: i think it's important to give people who are watching a sense of the real depth of what you were going throw. i think people tend to see someone who has come out the other end in the sense that you survived, you're together, you're successful, and not understand the real seriousness of the symptoms that lead parents, let's say to be willing to give their children medication in your case, could lead a teenager to want to take medication, which is very unusual. can you talk about that? i mean, we can hear the words,
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depression, anxiety, but in the book you tell the story in a way that makes it very concrete, that allows us to understand beyond just the diagnostic words, what the experience felt like, what your day-to-day life was like. >> guest: i personally felt that i was just slogging along through life. it wasn't as the i was suicidal, although times i felt verdes separate during the initial period, wearing the brace. i just felt that life was xing and it was just getting through every day was just a task, and just onerous and a burden, as if i were walking through mud, and i didn't take a lot of joy out of life, and i saw my peers -- this is supposed to be people -- teenagers is not the happiest time of your life but people tell you they're supposed to be -- >> host: which is unhelpful. >> guest: very unhelpful.
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i did see friends of mine and i saw peers having what just teamed seemed to be a much easier time and more carefree time and seemed a pity and a waste to go through so many years feeling like this. >> host: did your parents notice the degree to which you were suffering? >> guest: they did notice to a sort extent and this is very common and i talk about this in a book. the foreign which teenager who are internalizing conditions like anxiety and depression, parents notoriously underestimate what the kids are going through, and i don't say this as a way to fault the parents. it's just that these are very suburb -- internal experiences that children don't share, and teenagers very forthcoming and i was not forthcoming with my parents. i didn't want to burden them. >> host: it was interesting the way you described your experience with therapy as horrible extrusion and you
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described other children who also experienced this in the same way. and i thought that was very, very interesting because i don't think adults tend to experience therapy in that way because they choose to go. >> guest: exactly. it's not -- it felt like a punishment went you have an eating disorder and we don't know what to do with you so we're putting you in therapy. my parents were doing the best they could. they don't know what to do and therapy is a very reasonable first step. my parents were very hesitant to give me medication. i think a lot of parents -- you see this in -- it's not michigan they jump to readily, like they're excited to put their kids on medication. they have concerns about it. the problem is i think especially for teenagers and even children who are not very good at are -- articulating their feelings, it takes a skilled therapist to pull out
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their feelings and to make progress with the child. and so i think that medication can be in a way really anonymous in a great way. it can be a way of sort of keeping your private problems private if you want to. but also feeling like you're making some progress. >> host: it's interesting because you describe your feeling when you began medication, that it was liberating, it was freeing and allowed you to be the person you knew you were. this really runs counter to the people view medication -- the phrase is often used a chemical straitjackets, makes kid compliant and opposite of liberating. >> guest: that's trial. think, again, this partly depends on the age of the child. i had had a happy childhood so i knew what is was to be happy and
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then i knew what it was to be deeply unhappy. however, think even very young children can be aware and deeply aware that something is really wrong with them, and i interviewed some of my peers who described knowing they were different, knowing that they were depressed, and anxious, and -- from kindergarten onward, and so i don't think you have to be 17 years old or 15 years old to know that something is wrong. i think even very young children can feel that. >> host: you enter individual a lot of people, a lot of young adults and a lot of researchers, christian -- clinicians but you nerd the story on claire, elizabeth, paul, caleb, and alex. how did you come to your people and how did you come to focus on these five? >> guest: well, the first thing did is i just looked for anybody
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who would talk to me about their experiences, and that could be difficult because there's still really a lot of stigma around this, and i wasn't sure yet whether i would be using people's real names so i couldn't guarantee that in the book. i found a lot of people online in patient communities and communities centered around the use of medication. what i looked for in selecting -- i gradually narrowed down the group from several dozen to finally to those five. when i looked for -- looked for people who felt they had had a complicated experience with medication but who weren't zealots on either side. because i felt that story had been told. we have heard about the miracle transformations and heard about the people who believe that nobody should ever take medication. and so i wanted to represent a range of experiences and a range of backgrounds and also range of psychiatric conditions.
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>> you did. you tell very, very rich stories that don't reduce these people to theirs, which is great, because you -- to their symptoms, which is great. you place them in a context of their lives, some of which are difficult at least. one of which is awful and that's the story of paul, the former foster child. can we talk about his story? because i think that his is the one that really stayed with me the most. it's probably the least typical of the experience that most middle class kids have, and yet it's children and former children, like paul, who are really at the epicenter of the debate going on right now about medicating kids. >> guest: one reason i wanted to include a former foster child is foster children are medicated at many times the rate of their counterparts, even their counterparts who are on public insurance, and it has been in the media. there's been these scandal stories about kids being
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massively overmedicated and wrongly medicated. so i wanted to say, what does that feel like to the child? paul's experience, i would say, if we're looking at a spectrum of people from the most mosstive to the negative hurricane is it one of the most negative from medication. he was taken from his parent' home at five years old. they were not married. his father was abusive. he lived in a neighborhood where he was beat up by older children and basically indock crinated into gangs -- indoctrinate into young versions of ethnic gangs and he bounced around the foster care system from placement to placement to placement, just longing for somebody to adopt him. >> host: the story of the one placement you tell, which is a therapeutic placement, meant to be temporary in short term, which is not explained to him, that he loved when he wanted to stay with these parents and then yanked away from them for reasons he doesn't understand,
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with other kids coming in and being adopted. that's a heartbreaking story. >> guest: it is heartbreaking, and what makes the whole story even more heartbreaking is he was given medication, which i don't think was necessarily unjustified. i haven't seen his medical records, so i would have hard time saying that it was absolutely the wrong thing to give him medication. but nobody explained his medication to him. and they didn't explain details like the fact that this was a temporary placement. so, even though he was seeing therapists and psychiatristist in special schools and a whole raft of services, people weren't relating to him they way they should have been and medication did feel to him lick a -- like a chemical strait jacket. is was something because he was a bad kid. >> host: sounds like it didn't work for him. this is a child who was traumatized from an early age. it at least in in his telling,
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doesn't sound like he ever had anyone really deal with that trauma or try to help him therapeutically work through the trauma. >> guest: that is the sense i got as well. he had therapist. doesn't sound like the therapists were very effective. sounds like they were trying to fit him into certain categories and say, you have anger problems or this or that, but not to work through the really difficult things that he had been through. and in fact many of these things were so difficult and painful he still can't talk about them today and couldn't tell me the details. >> host: he was given different diagnoses, medications. don't remember them talking about ptsd or reactive attachment disorder. it seems he went from sort of trendy diagnosis -- i had taking about they but that's what it sound like do and ended up -- it's almost as though if you were creating a fictional comp
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co-composite character about everything that gross wrongs it's hem. he ends up with diabetes, overdoses, interpreting the medication as being to control him and control his behavior because he is bad and certainly the way it's presented to him. how did he turn out in the end? >> he has turned out remarkably well. he is a really impressive young man. he is now married to a young woman who has a young child of her own. he adores the child. he is going through school slowly because he has to work through school. but he has done an amazing job at really forming partnerships with mentoring adults finally. i think he, after having a childhood where he didn't have adults looking out for him or not adults he could rely on for long periods of time, for
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unconditional love. he has done a great job of seeking out mentors and has sort of found religion, and we can be critical of that but i think it has filled a void in his life and it has made him feel deeply loved and unconditionally loved in another way. >> host: certainly seemed that way. you refer to parents. did a couple finally adopt system. >> guest: no. he was never adopted. but he -- like i said, he does have extremely close relationships with a number of adults now who are essentially adoptive parents. >> host: he was left with great resilience, given everything he had gone through. >> guest: remarkable. >> host: elizabeth and claire, very different. can you talk about that? >> guest: sure. claire is an interesting example because she is the daughter of mental health advocates. her father has schizophrenia and
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became and is a prominent advocate for people with schizophrenia and the argue. they can be high functioning and do extremely well in society. and so her parents were more on the lookout for problems than the average parent, even so, what was so interesting about her, was that childhood mental illness is so rarely diagnosed in the early '90s when she began to have her problems, they just didn't know what to make of her meltdown. they thought it was who she was and more quickly recognize it probably than other parents would have and took her to a pediatrician who described an antidepressant but it was striking that even they didn't say, oh, that's depression. because the concept of depression in a child was a new concept then. >> host: and her problems were different from her fathers. so he wouldn't have necessarily recognized himself in her right away. you refer to claire as having to
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become the poster child for youth depression and pharmaceutical treatment because she made a documentary. she standard in a documentary basically that was shown at advocacy meetings, talking about her experience, which is a very, very helpful thing to do for kids but i wondered what was the effect of that on her? that was a tough role. she did that young and had to remain in that role for a long time afterwards. >> guest: what is interesting is even hoe she was a poster child she didn't have this miracle turn-around on medication the way two of her siblings, who were close in age to her, did also take ssri antidepressants and had great responses. they weren't the poster children because they weren't as inclined to play that role. she was very dynamic and are articulate and et cetera, et cetera, and medication all side effects for her so at the same time she was trying to explain depression and explain that it
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was a condition that could be treated well, she was also struggling to find a medication that didn't make her too exhausted to function, and too exhausted so she was falling asleep in class. >> host: probably would have been, i imagine, even more helpful to people if that side out her story had come through strongly as well. that is a relatively typical story, these medications have strong side effects, they don't work for everyone. they can work wonderfully for some people. they truly can be life changing. and life saving for a lot of people. but for other people, it's really an odyssey that can be on all their lives. >> guest: absolutely. that can be incredibly difficult for children to struggle with and they're trying to understand the nature of their problem and they're told medication is supposed to help them and alleviate the symptoms and the medication doesn't do that, that can be difficult for though sustain the commitment to taking
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it and just to really feel that it's worth it and to trust their parents and their doctors for years on end while the medications don't really do what they were promised to do. >> host: this, is an interesting parchment she is maybe be their in some ways and some ways not the polar opposite of paul. she is from a privileged environment and yet she is disconnected. so she is privileged and profoundly disconnected from her parents who are profoundly disconnected from each other. so they have ha the commonality. >> guest: elizabeth grew up' in the wealthy suburbs of washington, dc. her father was a prominent lawyer and her mother was beloved local politics and that sort of thing. and they had a very difficult relationship. her father had problems with alcoholism that caused problems
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in the marriage, and she began to have real dysfunction in middle school, where she just was unable to turn in homework, and really depressed, was ultimately diagnosed with both adhd and depression and given two medications another once which complicated matters because she had trouble telling which drug was doing what. >> host: so one of them was given in sort of a trivializing way. give this because it can't hurt, almost. >> guest: exactly. they didn't really diagnosis her with depression. they said, some kids who have adhd get depressed about the fact they're not doing well in school and she what not do well in school, almost plunked out of her private school. so they threw it at her and that made it extremely difficult for thor be committed to the medication and sort of gauge what it was doing. and ultimately she ended up going off it without telling her doctor. i think, in part because she
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wasn't acclimated to it in the proper way. >> what happened then? >> it did not work out well. she started cutting herself. doing self-injury, and she didn't immediately make the connection between the fact she was an antidepressant and the cutting but she felled into a deep depression and went for a couple of years -- tike her quite a while to realize that probably she was indeed depressed, that this was not just teenage angst, that she was go to romanticize and realize this something she needed help with. >> i was struck how supportive her friends were of her. they were really there for her and really pushing thor get treatment when she was cutting. >> guest: i thought that was great. that was a function of her feeling comfortable telling her friends about her problems, and many of the young people i interviewed were not comfortable telling their friends, or if they did it happened in a casual
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way. i myself mentioned to my friends i took medication for anxiety and depression, and i still will sort of mention it but i'm not inclined to want to -- i don't want to burden them, and i think that's a common impulse, and also, with teenagers and kids it's difficult to find the vocabulary to explain these feelings and what you're going through and explain that to your friends. >> host: it's interesting. parents, particularly who don't have children with mental health issues, tend to believe the kids talk about it all the time and everyone is on medication and they joke about it and at it completely normal and banal and what is happening to our kit. that's not the truth, is it? >> guest: i think there is a sort amount of joking about it in a really superficial way which does not help at all. and it certainly doesn't help the kids who are actually struggling with these problems. it actually makes them less likely to want to confide the their peers because they see
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their peers are not taking it serious and with medication for adhd, i interviewed people who were short of ashamed they took it. felt their peers were going to judge them, they were getting an unfair leg up. >> host: we have to take a brake, so -- break, so when we e back i'd like to talk a bit about the issue of the unreliable narrator when you're talking to young adults and teens, and also talk more about what kind of conclusions we can all draw from these stories. >> okay.
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>> back with kaitlin bell barnett, talking about "dose: the medication generation grows up." >> host: well we were on break you talked about the perplexing fact that for many of these kidses their diagnoses change over time. their symptoms morph over time from one set of problems to another, and that you heard this over and over again. can you talk about that? >> guest: could pose a real challenge and did pose a real challenge for many of the people i interviewed. the sort of thought they had everything figured out. i was one of those people. i thought that my problem was depression and then later on in my early 20s i began experiencing severe anxiety, and especially when you get a pill and you -- the pill works well, it can be really destabilizing to feel that, no, indeed you don't have it all figured out and you have problems, and this happens really commonly, and one of the most common scenarios
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where it does show up is you'll see depression with one of the subjects in the book, caleb. he was diagnosed with a severe depression as age 12, and had really a fabulous miracle turn-around on zoloft where his depression did not completely go away but he had been so suicidal that to him it felt as if he had been lifted from the depths of hell. and a few years later he began experiencing completely new symptoms that later turned out to be mania, and he was diagnosed with bipolar disorder but it took quite a while for his doctors to figure out what was going on, and he didn't know what was going on. he thought he just didn't need his medication anymore and had been somehow cured magically or that he was undergoing some other hormonal shifts, like a second purity -- pew bertty and
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that is an example of the changes that can happen with a young person who is growing and changing. >> host: a turning opinion for him is when he found himself on a bridge contemplating suicide and the fireman came and saved him. at least he was found and was treated. there's a problem that recures in the back of kids wanting treatment and not being able to get it. not being able to be noticed or admitted to a hospital when they feel they really need intensive treatment because regulations have checked in such a way, insurance reimbursement changed so many fewer hospital beds. can you talk about those systemic problems? >> guest: sure. that does happen. that happened specifically with one of the subjects in the book, alex, who was undergoing much more severe symptoms than he experienced when -- he started treatment in ten, and then in
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his young deanage areas but he could recognize he was -- he felt possibly suicidal, and he wanted to be admitted to a hospital, and he didn't have a specific plan to kill himself, and they would not admit him. and that's not an uncommon story. >> host: is a recall in order to get admitted eventually, he had to lie and say he was suicidal. >> guest: he did, yes. >> host: which is incredible. so sad. now fortunately none of these people ended up in the criminal justice system, which is a typical, not unfortunatelily thing, that happens to kids with untreated struck needs which ended them in prison, and maybe they get diagnosed and maybe they don't but too little too late at that point. >> guest: the other thing that happened to him that is indicative of a larger systemic problem is that he was only comment the hospital when he wassed mitted for fours days and
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that's not long enough. from what i understand talking to the doctors who work in these hospitals, to get any kind of real sense of whether a medication is working. so if they switch you to a new medication, there's some sort, acting formulations and they can tell certain antiscottics made him feel better, but if they're switching something like an antididn'tant that takes weeks to work, four days is not nearly enough time, and especially if they want to wean him off the drugs he was on. he was released and a few weeks later he very nearly tried to commit suicide and that's not uncommon for these short stays to result in some sort 0 of drastic event like that, that may result in a readmission to the hospital. >> host: there's a perception that this is the way psychiatrists want it. you see stories sharing that psychologist happenly conducting these 15 minute check sessions and not having continuous
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followup with their patients because it's a way to make money, way to make a lot of money, becomes very difficult otherwise. is that what you found? did you find sort of satisfaction among psychiatrists with the way things are happening right now? there is no doubt that most of the kids you were talking to were getting very quick, very preemtorre treatment. how did the doctors feel about what they -- doing? >> guest: i didn't make a point of doctors who believed in a more joint therapeutic approach. they were know interested in how the medications affectedded the kids and were asking the questions of the young patients but that whole cadre of psychiatrists -- they're not happy with the way things are and they feel enormous financial pressure and pressure from the insurance companies to conduct these 15-minute med check is the
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cliche, and they were not happy at all and that's why many psychiatrists don't take insurance, actually. >> host: which is a whole other problem because it means you have this bifurcated system where only the wealthiest kids are able to get the top quality treatment, and we see this so clearly with paul, the foster child, who gets really disjointed treatment, and i've heard other stories of that type where a psychiatrist may be prescribing marylands to a child acose full record is never actually seen and flying blind, not by choice but this is what he has to work if. >> and the parents' insurance may shift so they have to see a new provider and go from one person to another to another. i interviewed, i think -- i can't even think of somebody dish wish i could just for the sake of the doctors but i can't think of somebody who said they
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had a really close, really long-lasting therapeutic relationship with a psychiatrist. >> you know, it's always a problem with these books that you get the story you get in part because of the kinds of people who you talk to. the people who you talk to when it come, to let's say, psychiatrists ---the most thoughtful in their field, thinking and talking about this and you get their perspective. you don't know if the kind of front-line clinicians on the ground are thinking the same would and operating the same way, are fulfilling the various stereo types about them. did you have that feeling of frustration? >> guest: i absolutely had that feeling, and i suspect some of the less productive interviews i conducted were perhaps with some of those clinicians who were not thinking about these issues or just too rushed, didn't have the time to reflect. the ones i talked to in detail,
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it was a skewed sample and that did concern me because i wanted to get the bigger picture of the state of child psychiatry in america, and that would have been a different book. >> it's difficult to get hard data that will give you answers on the state of child psychiatry in america you. get little bits and petes, for example, how many child psychologists take insurance is possible, our how exactly the sessions are happening, what discussions are taking. >> have to work with the sample you have to arrive with the information you have. did you question yourself about hugh to work from material womaning from young adult -- everyone was a young adult by the time you got to them. you weren't interviewing teenagers at the time. now that i'm old i realize that through certainly through your adolescence, even through your early adulthood, you're kind of an unreliable narrator because
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you don't have the full range of information of your early years and you never get it but you also don't have the perspective necessarily to fully understand what was happening and sort of be able to put yourself in the shoes of the adults in your life. did you ever look at your stories as the narrative you were hearing, the testimonials you were getting and wonder, where there pieces missing? did you talk to the parents along with the kids? what was the basis? >> guest: i did my best whenever i could a talk in the parents and the kids, and in paul's case i did try to talk to a couple of his caregivers to get the other side of the story. especially when we were talking about children that began treatment young and the parents instigated it. i wanted to know how and why did that happen? but certainly i felt very conflicted because i really wanted to give credence to what
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they consider saying. i wanted to take their opinions seriously and that was part of the mission of the book is to let them tell their story. i also didn't want to present the information unquestionably. they have their own biases and views, and there were times when i felt like i didn't necessarily doubt what the facts of what they were saying but i thought it could be interpreted in a different way. i think paul is one example where i could certainly imagine that he could have been a very troubled little boy where his caregivers would have been really at a loss what to do with him, and where medication might have seemed like a reasonable option. >> host: and yet in these different cases, the degree of knowledge the kids have, the young adults have, the ability they have to talk about their experiences and conceptualize
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them -- did adults communicate with them properly? were adults connected to them? did adults empower them? they were vast differences. >> guest: there were. i think claire is an example. claire's parents were mental health advocates on one side of she spectrum of getting a really detailed information from her parents about depression, about the nature of it being perhaps a chronic illness that might require treatment indefinitely even. and some people might say that's a negative take to get the child, but in her case it sort of turned out to be realistic, because h medication did not work perfectly and she had 0 to use different ones. and other kid got extremely little information, and i
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concluded the more information, the better they fared. >> host: the more connect they were to the dahls in their lives the better they fared. the disconnection of a lot of the kids was really, really striking. paul, elizabeth, alex -- thank you talk about alex's home life? >> guest: sure. alex was born out of wedlock to a mother who -- his father was married to another woman and had another child, and he grew up sort of knowing his father but feeling very disconnected from him. he was very close to his mother but when he was about nine or ten years old his mother started having a couple of serious boyfriend weather moved into the house. one of them became his stepfather, and he got along very poorly with them. they were, i think, arguably emotionally abusive. and tried to separate him from his mother, and so i think he
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probably got less attention and less explanation from his mom than he would have if she had been able to sort of fully devote herself to him without feeling like she has to childhood between him and -- >> host: certainly sounds as the his stepfather was very undermining of his treatment, his efforts to get treatment, saginaw treatment, he have this kind of view that americans are overmedicated and always trying to find easy way out from their problems and need to be more stoic and tougher. that alex tried to identify with that and did identify with it but it didn't work for him. >> guest: that's right. his stepfather had epilepsy and did not take medication for the appears lens si. he had this macho idea that one doesn't take medication for one's problems and you just tough it out. and alex ultimately went off his medications in high school for several years, with the permission of his doctor, but hoping he could sort of tough it
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out himself, and it was blow to his self-esteem and his sense of self when he relapsed and experienced much more severe symptoms that did require him to return to medication. >> host: that brings up these identity issues you raise throughout the book. you talk about the role that medication plays in the formation of identity. that is one of the big areas you wanted to explore here. you talked about how having a specific diagnosis can give someone a sense of an identity that can be too narrow, let's say, so the diagnosis shifts or the medication doesn't work, it isn't just the suffering of whatever symptoms are coming back or the disappointment but a whole sense of self that somehow gets destabilized. can you talk more about that? maybe about more in your own case and more in the case of some of these other people? >> guest: sure. i think that sometimes having a label could be very helpful for many of these young people,
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because it was relief and validated what they were going through. claires brother, who i interviewed, a bit, and tell the story briefly in the book -- his name is joe -- felt very ashamed of being depressed and opposite it had a name and he was given mid indication he felt really validated and no longer felt that was something he needed to hide or just be ashamed of. and i also had that sense. i felt like medication was, like, proof there was something wrong with me. but then -- and that i deserved treatment, and i deserved something serious. but on the other hand, when these kinds of shifting diagnoses, you think you have it figure out, and a lot of times you don't, and that's nobody's fault necessarily. the doctors are doing their best to come up with the proper diagnosis. but it is notoriously difficult to diagnosis children, and they
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grow and they change and sometimes they develop what are called conditions that coexist with the previous condition, and that shows up later. so in my case, it became a problem, the dominant problem later, only later when i was in my 20s. the same happened for claire, actually, who also was unprepared to deal with her anxiety because she was so used to thinking of herself as having depression. >> host: a person who just plain as opposed to medicating of children, possibly adults, too, under any sticks, is opposed to psycho tropeic meds addition, that we are overdiagnosing, et cetera, that whole can of worms, would say, if these kids hadn't been met indicated in the first place maybe they wouldn't couple up with problems later.
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maybe the medication changed their bryan and the depression became anxiety and adhd or depression turned into bipolar disorder. how would you answer that? it's what a lot of people think. >> guest: well, there is, i have to say, some evidence, some serious researchers, who are exploring these possibilities. so it's not a completely whacky, insane concept. i think in most cases it is probably not the case. i think that it's very common for their to be this co-morbidity where people develop multiple continues throughout their lives. stressors trigger new symptoms. however, die discuss in the book the possibility that, for instance, antidepressants are known to trigger mania, and there is a line of research
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going on to discover whether that makes people who are prone to developing bipolar disorder to develop it at a younger age even than they would have if they had never taken those medications and it's an intriguing and haunting possibility. i think the science is not there yet to answer that question, but if it were true, it would be very upsetting. >> host: very upsetting and very problematic because the fear of that then drove a lot of doctors in the early 20,000s 2000's to prescribe fewer stimulants and fewer antidepressants and more atypical psychotics for children of bipolar disorder, not who are necessarily schizophrenic. these drugs have terrible really dangerous side effects. can you talk about those medications, how they came on the market and what the expectations were and then what the fallout has been?
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>> guest: sure. they initially came on the market in the -- '80s and then through the '90s and they were foresights friend ya and adults and then increasingly prescribed for a new content so bipolar disorder and to treat aggressive behavior different -- disorders in kids as well, and it didn't come out in studies until several years after the millennium, wasn't established they could have serious side effects, including causing massive weight gain, rapid weight gain, and type 2 diabetes. >> which is what happened to paul. >> what happened to paul after he had taken one of this atypical antipsychotics for a couple of years. and nobody warned him of that possibility or discussed other options for him. and i think this concern about
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possible long-term side effects can be really problematic because for certain drugs like stimulants because you can get a drug that causes much more certain or much more likely short-term and very serious side effects. >> host: it makes its such a difficult decision for parent whose want to know what to do and there isn't great science to guide them. talk about that a bit. why isn't there more research specifically focused on children? >> guest: well, partly it has to do with ethical issues about either -- with a controlled study, randomly assigning children to treatment or giving them no treatment. part of it is a real lack of long-term research, longitudeat studies tracking kids for many years to see how the medications affect them over the course of their development. and those studies are enormously complicated to conduct.
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they require all kinds of followup and whole apparatus of tracking the people down years later. they're very expensive and they require a tree e researcher to devote his or her career this subject. not everybody is willing to do that. also difficult to secure the funding for those studies. we do have a study like that it for stimulantses that was funned by the nimh which has given some interesting results, some of them troubling, some of them just suggest a way that we can deliver much better care in our society but at the same time even those results are hotly debated each time a different piece comes out. there's more debate. how do you cut through senate how does a parent cut through that? >> guest: it's such a difficult question. i think that parents should do their research as much as they can. but i think that really a key thing is if they decide to medicate their child, they shouldn't look at it as, this is
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an every/or decision and this must go on forever, that it decide to medicate my kid and there's no going back. it's important to have a continuing discussion with the doctor, to get second opinions, to -- if you have access to a therapist to talk to the parentist about the idea of medication to talk to the child's teachers and also very importantly to check in with the child, him or herself, to see how they feel about the treatment, and to try to make them partners in the treatment as much as possible. because i think it's so important to take the kids' opinion seriously and check in how the medication is affecting them. >> host: there's so many negative experiences in the book, on news shouse, bad experience, medication, short visits with psychiatrists, adults who don't get it. when people have positive experiences, what were the
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elements of those treatment forms, those experiences and those encounters or relationships? if parents are setting out to try to get good care, where should they start and what should they be looking for? sunny think that a doctor, again, who really takes the child patient seriously and takes the parents' view seriously is key. you want to have a doctor who respects any doubts the parents have and also any doubts he feels the child has and is willing to explain to the child. if the child is afraid the medications are going to make him crazy or change his whole personality, fears that kids have, or that even if they're a little older and they think, this is just going to make me into a less interesting person or less funny person, the doctor takes those concerns seriously and explains them, explain how the medications work. also, be honest about the fact
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that the doctor -- that doctors don't know exactly how the medications work and that it's a process of trial and error. so i think, looking for a doctor who doesn't predon't be all-knowing and doesn't pretend they have all the solutions and is willing to be nebraskaible and work with -- flexible and work with the family and child is important. >> host: a pediatrician or child psychiatrist? there are only 7,000 child psychiatrists in the country so for people outside of areas of new york or washington, it's hard to get access to a child psychiatrist. >> guest: yes. it could be a pediatrician. i think there are enormous pressure unipeds contributions the same way on cysts to have short vieses where they don't have the time to either accurately diagnosis the child or to follow up with the medication. but if parents can find -- can do a little looking and reading around for a pediatrician who
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doesn't have as packed a schedule and who is willing to consult with a child psychiatrist or consult with a therapist so there's communication between the doctors, they're not reimbursed for that, unfortunately, by the insurance company. >> host: makes it very difficult. very time consuming, and they're all under pressures, too. now, we're starting to need to wrap up. i want to ask. you have a yeley nice phrase in the book, the legacies of medication. what do you see of the legacy of medication for yourself, for these kids who you interviewed, and for us as a society? >> guest: i think for both myself and so maybe of the young people i interviewed, the legacy was that it made sort of determining what your problems are and what your capabilities are more complicated. medication really ads this extra layer of complexity, as we discussed, in so many different
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areas and makes the idea of figuring out who you are, your adult identity, a more thought process and perhaps even more of an ongoing process as you continue maybe into your 20s and 30s to try to experiment and find a medication that really works for you. i think as a society, the legacy is that we need to take children's opinions about their medication more seriously, and not just -- i'm not saying we're just throwing medications at kids, but i think that insofar as we give them medication, we need to understand that they have opinions about those medications, they experience things that in many ways similar the way adults do, and it can be traumatic it can be scary, but the need explanation and guidance along the way. and i hope that for this sort of next generation of kids growing up now, and are medicated, and also for the kids that people in
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my generation will have, if they take medication, they'll be able to benefit from a little more sense of the many ways medication can affect you. >> host: so yours is not a pro or antimedication argue. it it's an argument for delivering what care is delivered in a better and more thoughtful way, as i hear it. is that correct? >> guest: exactly. >> host: this is a big question everyone asks. do you think that american kids are being overmedicated? >> guest: i think that the question is impossible to answer because i think it would require assessing every case. it would require saying how many kids should be medicated, and i don't know how any of us can say what the proper number of children to be medicated would be. how many hundreds of thousands or million kids would be the right number? i just hope that insofar as kids are getting this care, it's done in a sensitive way and in a way that is productive and helpful
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for their long-term development as possible. >> host: there is a serious problem right now of abuse of medications, specifically of stimulants. that gets a lot of media attention. doesn't necessarily help in terms of understanding why kids are being prescribed medication and need it. it does point to the pressures that are bearing down on the kid. feel like they have to be superhuman. to what extent do you think we can indict society for kids mental health problem should be we indicting society? should we have a more biological screw say these kids would have problems no matter what? where do you come down? >> guest: i think it's a combination. i think many of these children would be having problems and did have problems in previous generations and the problems weren't recognized. i think we live in a more -- a much more high-pressure society where we don't toll late blips or failures, and that i don't

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